Enhancing learning in clinical placements: self assessment, rubrics and scaffolding (a case study)

1. Enhancing learning in clinical placements: self assessment, rubrics and scaffolding (a case study) Ieva Stupans University of New England Geoff March &Susanne Owen University of South Australia

3. Australian UG pharmacy programs • 4 years, include clinical placements , at graduation not competent , require one year intern period and assessments etc in order to be registered. • Therefore program endpoint is not specified. • However program must enable student to commence intern period. • Assessments of clinical placements in pharmacy generally based on assessment of individual activities not assessment of competency as such. • These activities may be based around competencies

4. Competency Standards for Pharmacists in Australia • Eight domains • Standard 1.5, element 1:importance of life-long learning, self assessment, reflective learning

5. Learning activity based around counselling • Each student required to undertake counselling throughout the placement • Write a reflective piece regarding their improvements in counselling between the early and late stages of the placement

6. Learning activity based around counselling • Each student required to undertake counselling throughout the placement • Three iterations of the activity developed A, B,C • Evaluation • scoring of various facets • determining types of reflection demonstrated in the writing

7. How would you scaffold this activity? • Write a reflective piece regarding their improvements in counselling between the early and late stages of the placement

8. Scoring: Understanding of role and function of Competencies - uses competency developmental criteria language, refers to relevant performance criteria C A Marks

9. Scoring: Clear thoughtful analysis – makes connections between experiences, course material and other relevant events (Reflection) A Marks

10. Examples from the qualitative analysis for reflective writing Reflective observation involving explaining actions: • “I became better at identifying a particular patient’s information needs. I was able to tailor the type and extent of information provided to the patient depending on the number of other medications and also the patient’s cognitive level”

11. Examples from the qualitative analysis for reflective writing Abstract conceptualisation involving linking to other experiences: • “ the level of support from my preceptor needed.... the time taken for me to provide..... degree of client focus also improved” Abstract experimentation/theory confirmation involving discussing future action • “I would look up tertiary references (such as the Australian Medicines Handbook) for important counselling points”

12. What were the differences between the 3 iterations? • A- Write a reflective piece regarding your improvements in counselling between the early and late stages of the placement • B- Write a reflective piece regarding your improvements in counselling between the early and late stages of the placement Plus description of reflection Plus graduated descriptors around competencies • C-Write a reflective piece regarding your improvements in counselling between the early and late stages of the placement Plus description of reflection Plus graduated descriptors around competencies Plus rubric and specific scaffolding

13. RO-reflective observation; AC-abstract conceptualisation; AE-active experimentation; CE- concrete experience

14. Reflecting and Goal Setting 1. Setting of professional goals Reflection-for- action Reflection-for-action 4. Active change by experimentation and practice 2. Evaluating strengths & needs 5. Developing Supportive Networks 3. Planning Learning Agenda

15. Rubric: Explain • what the most significant changes are, • why changes in competency skill development are occurring • describe the evidence for this change • describe the change you have observed in terms of the links to pre-placement and during placement support/learning materials and • your action for the future in further developing your proficiency in this skill.

16. Journey to competency Criteria • Level of support • Time taken for preparing for the task • Time taken for doing the task • Clinical problem solving • Degree of client focus

17. Journey to Competency Example • Focussed on self • Partly client focussed • Mostly client focussed • Sufficient process skills forclient focus

18. Reflection- in, on, for action- Placement period B in

19. Reflection in, on, for action- Placement period C

20. Summary

21. Reflection is an essential element of lifelong learning and professional development • Self assessment in itself is meaningless unless it leads to planning Conclusion • Students with appropriate scaffolding can plan for future personal development i.e. Reflection for action

22. Scaffolding or Assessment ??? “from our students’ point of view, assessment always defines the actual curriculum” (Ramsden) “Assessment defines what students regard as important [and] how they spend their time… If you want to change student learning then change the methods of assessment” (Brown) “Assessment systems dominate what students are oriented towards in their learning” (Gibbs)

23. Zone of Proximal Development Learning

24. What ideas could you incorporate into students’ activities?How do you prepare students to go on placement?